Nurse, Case Management

POSITION PURPOSE:
To support the case management initiatives through the delivery of medically necessary and appropriate, cost-effective and quality care through the performance of accepted Case Management practices by using the core components of Case Management.

1: Processes and Relationships
2: Health Care Management
3: Community Resources and Support
4: Service Delivery
5: Psychosocial Intervention
6: Rehabilitation Case Management

Carry out the Population Management program.

NATURE AND SCOPE:
Responds to requests for case management. Works collaboratively with Care Coordination, Quality Management, Providers, and other internal and external customers to manage selected member’s complex health care conditions to achieve the most appropriate outcome while promoting the most cost-effective use of available resources.

Assures the provision of verbal and written communication of case management with the member and provider. Assures the essentials of case management, such as assessment, planning, implementation, coordination, monitoring and evaluation are performed as appropriate. Practices within the scope of licensure and standards related to Case Management.
REQUIREMENTS
POSITION REQUIREMENTS:

Valid Idaho Registered Nurse License. BSN preferred.

Strong background and experience in the following:
oClinical Nursing
§Medical and surgical inpatient and/or outpatient care (3 years)
§Specialty care (2 - 3 years, preferably cardiovascular, endocrinology, oncology and respiratory)
oManaged care delivery systems including Medicare plans
oUtilization management/Care Coordination or Case Management
oQuality improvement
oNational Commission on Quality Assurance (NCQA) or Utilization Review Accreditation Committee (URAC) accreditation
oCenter for Medicare and Medicaid Services (CMS) standards for Managed Care Plans

Strong interpersonal skills. Strong abilities in verbal and written communication with diverse audiences and the ability to give and receive constructive feedback in a team environment. Ability to schedule time effectively, work with minimal supervision, handle multiple projects simultaneously and prioritize work appropriately. Ability to access and use various computer systems. Strong analytical and problem solving skills. Good organization skills. Knowledge of CPT-4 and ICD-9 coding. Independent thinking and self-motivation. Strong negotiating skills.

To search and apply for employment opportunities visit our website at www.bcidaho.com/careers. Come work for the leading Health Insurance carrier in Idaho. We offer excellent benefits and competitive salaries, including incentive programs, 401(k), paid holidays, and much more! EEO/AA/D/V